Madelaire Christian, Gustafsson Finn, Stevenson Lynne Warner, Kristensen Søren Lund, Køber Lars, Andersen Julie, D'Souza Maria, Torp-Pedersen Christian, Gislason Gunnar, Schou Morten
Department of Cardiology, Herlev and Gentofte University Hospital, Denmark.
The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark.
Int J Cardiol. 2020 Apr 15;305:106-112. doi: 10.1016/j.ijcard.2020.01.055. Epub 2020 Jan 23.
Heart failure (HF) is widely associated with a median survival of 5 years. However, population level data on survival and HF progression has been limited for key subgroups. We assessed survival and HF progression, defined as hospitalization or outpatient diuretic intensification in patients ≤70 years without severe comorbidity, who received relevant medical therapy.
From administrative registers, we identified all Danish patients ≤70 years diagnosed with HF 2000-2012 without severe comorbidity, survived for 120 days to receive angiotensin converting enzyme inhibitors (ACE-I)/angiotensin receptor blocker (ARB) and beta blocker. Risk of death or progression of HF was assessed with Kaplan-Meier and Aalen Johansen estimators, respectively. Cox regression models were used to identify factors associated with risk of death.
We included 19,985 patients, median age 61, 25% women - 1/3 of all HF patients ≤70 years. We excluded 237 patients who died within 120 days and 21,065 due to severe comorbidity. Five-year cumulative incidence of all-cause death was 14% (95%-confidence interval [CI]:13-14). Risk of death was increased for patients first diagnosed in hospital compared to outpatient clinics (hazard ratio: 1.51, 95%-CI:1.38-1.65, p < 0.001). Five-year cumulative incidence of HF hospitalization: 18% (95%-CI, 18-19) and intensification of diuretic therapy: 14% (95%-CI, 14-15).
In patients ≤70 years without severe comorbidity, five-year mortality was only 14% and almost 2/3 were alive after 5 years without evident HF progression. Discussion of prognosis should be tailored to age and health status to provide realistic expectations for patients newly diagnosed and treated with recommended therapies for HF.
心力衰竭（HF）与5年的中位生存期广泛相关。然而，关键亚组人群中关于生存和HF进展的数据有限。我们评估了年龄≤70岁、无严重合并症且接受相关药物治疗的患者的生存情况以及定义为住院或门诊利尿剂强化治疗的HF进展情况。
从行政登记册中，我们识别出所有在2000年至2012年期间被诊断为HF、年龄≤70岁、无严重合并症、存活120天以接受血管紧张素转换酶抑制剂（ACE-I）/血管紧张素受体阻滞剂（ARB）和β受体阻滞剂治疗的丹麦患者。分别使用Kaplan-Meier法和Aalen Johansen估计量评估死亡风险或HF进展风险。使用Cox回归模型确定与死亡风险相关的因素。
我们纳入了19,985例患者，中位年龄61岁，25%为女性，占所有年龄≤70岁HF患者的1/3）。我们排除了120天内死亡的237例患者以及因严重合并症而排除的21,065例患者。全因死亡的5年累积发生率为14%（95%置信区间[CI]：13 - 14）。与门诊诊断的患者相比，首次在医院诊断的患者死亡风险增加（风险比：1.51，95%CI：1.38 - 1.65，p < 0.001）。HF住院的5年累积发生率为18%（95%CI，18 - 19），利尿剂治疗强化的发生率为14%（95%CI，14 - 15）。
在年龄≤70岁、无严重合并症的患者中，5年死亡率仅为14%，近2/3的患者在经过5年且无明显HF进展后仍存活。对预后的讨论应根据年龄和健康状况进行调整，以便为新诊断并接受HF推荐治疗的患者提供现实的预期。
